title: Freeze-dried plasma at the point of injury: from concept to doctrine.
abstract: While early plasma transfusion for the treatment of patients with ongoing major hemorrhage is widely accepted as part of the standard of care in the hospital setting, logistic constraints have limited its use in the out-of-hospital setting. Freeze-dried plasma (FDP), which can be stored at ambient temperatures, enables early treatment in the out-of-hospital setting. Point-of-injury plasma transfusion entails several significant advantages over currently used resuscitation fluids, including the avoidance of dilutional coagulopathy, by minimizing the need for crystalloid infusion, beneficial effects on endothelial function, physiological pH level, and better maintenance of intravascular volume compared with crystalloid-based solutions. The Israel Defense Forces Medical Corps policy is that plasma is the resuscitation fluid of choice for selected, severely wounded patients and has thus included FDP as part of its armamentarium for use at the point of injury by advanced life savers, across the entire military. We describe the clinical rationale behind the use of FDP at the point-of-injury, the drafting of the administration protocol now being used by Israel Defense Forces advanced life support providers, the process of procurement and distribution, and preliminary data describing the first casualties treated with FDP at the point of injury. It is our hope that others will be able to learn from our experience, thus improving trauma casualty care around the world.
authors.affiliation: *Surgeon General's Headquarters, Israel Defense Forces, and †Department of Military Medicine, Hebrew University, Jerusalem, Israel; ‡Department of Pediatrics, Division of Critical Care, Washington University in St Louis, Missouri; and §US Army Institute of Surgical Research, Fort Sam Houston; and ∥Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Elon
authors.initials: E
authors.lastname: Glassberg
authors.forename: Roy
authors.initials: R
authors.lastname: Nadler
authors.forename: Sami
authors.initials: S
authors.lastname: Gendler
authors.forename: Amir
authors.initials: A
authors.lastname: Abramovich
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
authors.forename: Robert T
authors.initials: RT
authors.lastname: Gerhardt
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Yitshak
authors.initials: Y
authors.lastname: Kreiss
mesh_terms: D016913:Blood Component Transfusion / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D008887:Military Medicine / Q000379:methods; D010949:Plasma; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods; D014947:Wounds and Injuries / Q000628:therapy*